title: Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery.
abstract: BACKGROUND
  Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.
  
  
  METHODS
  A mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004-2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery.
  
  
  RESULTS
  Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians' to impact upon the quality of service delivery.
  
  
  CONCLUSIONS
  Among Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians' adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.
authors.affiliation: Centre for Rural Health, North Coast; Sydney School of Public Health, University of Sydney, New South Wales, Sydney 2480, Australia. sbarzeev@usyd.edu.au
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Bar-Zeev
authors.forename: Sue G
authors.initials: SG
authors.lastname: Kruske
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Barclay
authors.forename: Naor
authors.initials: N
authors.lastname: Bar-Zeev
authors.forename: Sue V
authors.initials: SV
authors.lastname: Kildea
mesh_terms: D000740:Anemia / Q000208:ethnology / Q000628:therapy*; D001315:Australia / Q000208:ethnology; D002657:Child Development / Q000502:physiology*; D002662:Child Health Services; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D012424:Rural Population